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Doctor bashing time again

As a physician I can always tell when my contract with the government is up because the doctor bashers come out of the woodwork.

This time it is the eminent intellect Roger Martin, recently voted No. 3 best thinker in the world in 2013 by Thinkers50. Mr. Martin believes that doctors control the levers of health care and should have money taken away until they control the overall health care costs. This is nonsense.

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Doctors are like pilots; they may fly the airplane but they don’t own the airline or tell it which routes to fly. Nor are they the major reason for costs, which according to the Canadian Health Institute are dominated by hospitals, diagnostics and drugs.

For example, a hip replacement has an overall cost of $13,100 (CITI 2006). The physician fee is $696, only 6 per cent of the cost (OHIP, 2014).

Mr. Martin further points out that doctors have had larger than average increases in income from 2003 to present. He neglects to mention that for 30 years between 1970 and 2000 doctors had effectively no increase in income and we were losing doctors in droves to the United States.

The doctors of Ontario offer great value to Ontario citizens. We have a lot to offer in helping the efficiency and efficacy of the system . Our current College of Family Physicians president Jonathan Kerr is working hard in collaboration with the ministry to make these things happen.

Fuzzy and misleading thinking from partisan thinkers like Mr. Martin do not help this debate. If Thinkers50 had judged Mr. Martin on this topic I doubt he would have made the list.

Dr. Franklin Sheps, Thornhill

I find it ironic that Roger Martin, the former Dean of the University of Toronto’s Rotman School of Management, who according to the Ontario Sunshine List made $401,335 in 2013, believes Ontario physicians, who according to the Canadian Institute for Health Information made on average $340,019 gross earnings before overhead in 2011-12, are overcompensated.

This is especially so since during his tenure as Dean of Rotman he instituted massive salary increases for professors in the school. According to the Ontario Sunshine List, business professors in the Rotman School who were making $119,000 and less in 1999 were making well over $300,000 and in some cases over $400,000 in salary in 2013 at the end of his tenure — increases of more than 300 per cent in salary — and these figures do not include fringe benefits such as pension and insurance, dental and health coverage, which experts estimate add the equivalent of anywhere from 15 to 28 per cent to a salary.

The professors also do not pay overhead for supplies, equipment or staff and have the opportunity to generate further revenue through external consulting. The average compensation quoted for physicians by Mr. Martin is gross revenue before overhead.

A study published by the Institute for Clinical Evaluative Science on physician overhead costs found that overhead ranges from 10 per cent to 38 per cent and overall is 26 per cent. Physicians are also financially responsible for their own insurance, health, dental expenses and pension.

Considering these expenses and the hours of work and level of responsibility assumed by Ontario physicians, they are definitely not overcompensated and I find it hypocritical of Mr. Martin to make this assertion in light of his history at Rotman. Those in glass houses shouldn’t throw stones.

Greg Sheehan, Mississauga

I take offense at Roger Martin’s assertion that “Ontario doctors need to step up and earn their keep.” This comes from a person who likely qualifies for a defined benefit pension – a dream for most physicians.

I am an internist, approaching age 70. In my section of general internal medicine, 38 per cent are over age 60 and 29 per cent are over age 65. Because of the economic setbacks, many have been forced to delay retirement.

Most maintain their livelihood by seeing consults and follow-ups in their office, yet overheads consume an ever-increasing percentage of their gross incomes. Therefore, many have relied on ECG interpretations in order to stay solvent.

In the spring of 2012, the Ontario Ministry of Health unilaterally removed the “solo visit” fee for private laboratories and cut the professional component for ECG interpretation by 50 per cent. Physicians reading ECGs for private laboratories saw their net fees slashed by 65 per cent.

Even those reading hospital ECGs found their fees to be reduced to about half of the rate paid by Alberta, British Columbia, and Nova Scotia.

Physicians do want to practice in a cost-efficient manner, but for persons like Mr. Martin to stigmatize them without consideration of the facts does little to achieve a mutually acceptable agreement between the Ontario Ministry of Health and the Ontario Medical Association.

Dr. Charles S. Shaver, Ottawa

Ontario needs better value for money in health care, Opinion April 20

Jamison Steeve’s article sounds like the false wisdom from an “expert” who has never actually dealt with a sick and needy patient. He apparently does not recognize that the demand for health services outstrips the ability for physicians to provide it. All the physicians I know are working full-out to provide that care.

He does alert us to a significant drain when he says, “the effects of care provided at the end of life are potentially underestimated.”

Family reunification brings older (65 to 80 year olds) into the country. These elderly people have never contributed to the infrastructure, will unlikely ever work, often have multiple and ongoing medical issues and by dint of their age will require significant medical care and medications.

Furthermore, many don’t speak English, necessitating interpreters during office and hospital visits. These visits will likely require twice the normal amount of time because each question and answer will have to go through another individual.

He states that evidence shows that population aging and its effects on health care are over estimated. As a remedy for financing these costs he suggests setting aside monies in a “fund” as we do for retirement. I am retired, having worked for 39 years. During those years I used the system only twice for minor interventions. I would suggest that my “fund” currently has a credit balance.

Perhaps other solutions could be considered such as reviewing when a person can draw on the health care system. For example, one must be a resident in Canada five years to become a citizen or for at least 10 years before one can draw OAS. Perhaps this residency periods (not just 3 months as currently) could be a model for health care.

While income-tested co-payments could be a solution, many taxpayers, young and old, could not afford the additional costs and would not seek medical help until the situation has reached critical proportions thereby increasing the ultimate medical intervention/cost needed.

One continues to pay taxes even into retirement into one’s “fund” of which 42 per cent is used for health care. To continue to stoke the embers of intergenerational conflict does a disservice to those who worked and paid their taxes willingly for many years and used the system sparingly.

It is a red herring diverting the creative thinking needed away from solutions to the pressures on our health care system.

Ron Willson, Markham

“Ontario needs to develop a more effective and comprehensive system of paying for health care,” writes Jamison Steeve.

In fact the province was offered a comprehensive and innovative system by a visionary physician government adviser, Dr. J.S.W. Aldis, decades ago. Per capita payment on behalf of rostered patients was advised and implemented as Health Service Organizations.

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